Conversations with ... Ardis D. Hoven, MD

GEORGE LUNDBERG, MD: Hello and welcome. I'm Dr. George Lundberg, Editor-at-Large for MedPage Today, and we are in Chicago at the annual meeting of the American Medical Association having a conversation with the new President-Elect, Dr. Ardis Hoven, who is in fact an internist and an infectious disease specialist in Lexington, Kentucky.

ARDIS HOVEN, MD: That is correct.

LUNDBERG: Thank you very much for being with us.

HOVEN: Thank you.

LUNDBERG: And congratulations on your election, which I understand was uncontested this time.

HOVEN: That is true. A nice place to be actually, thank you.

LUNDBERG: Yeah. And I was amazed when I heard that you were going to be the President-Elect, because I thought, if you were a woman President of the AMA, you had to be named Nancy.

HOVEN: Well, someone suggested perhaps I should change my name to Nancy, but it's too late for that I'm afraid.

LUNDBERG: Well, obviously that won't be the case. And so you've broken yet another barrier by --

HOVEN: Right.

LUNDBERG: I guess we'll call that the "Nancy barrier."

HOVEN: That's correct.

LUNDBERG: There are a lot of barriers for women in medicine, but not as many now as there once were. I mean, I've come up through all of that time, and you've come through some of it as well. But there are still significant earning disparities between women doctors and men doctors.

I know some of that has to do with hours worked, and some of it has to do with specialty chosen, but I think, when you sort that out, there's still disparity. What's wrong with that and how can we make it better?

HOVEN: There is still discrepancy. And we talk about the glass ceiling, for example, and women not only in practices, particularly large integrated practices, or academic practices, where they don't seem to be able to break through the glass ceiling. It does take work and effort and awareness. I do believe things are much better than they were.

On the financial side however, I think women underestimate their value, and they go into discussions about contract, what they're to be paid, particularly when they're on a salary as opposed to on their own, let's say, small private practice where they're generating their own income.

So I do think women tend to underestimate their value and that we must do a better job of asserting ourselves in that particular arena. "My value is as good as anyone else's," and we need to get that message out there.

LUNDBERG: Should they be taking testosterone pills, or is that unrelated to it?

HOVEN: Oh no, no, that's totally unrelated to it.

I think this has got to do with the fact that women for so many years felt that they were doing it because simply it was what they wanted to do and they loved to do, and in fact the monetary piece wasn't important to them.

I think that's true for all physicians. They don't go into medicine to make money, they go into it because of what they're passionate about and taking care of patients.

I think women have been a bit behind the curve in recognizing their worth and their value and their contribution. We're seeing now, when half of medical school classes are women, that that is going to change I think, with women now being in more places in more leadership positions. But we still need to look for women in leadership positions in particularly academic medical centers and academic environments.

LUNDBERG: Well, I agree with that. And I strongly believe in equal pay for equal work. I believe there should be federal law about that. Anyway, there's been a lot of movement, and a lot of it's been very positive.

Another area where I don't think there's been all that good movement, and that's the area of appropriate utilization of resources. I mean, I was at a meeting in Cambridge, Mass., about a month ago called "Avoiding Avoidable Care," and people kept talking about 30 to 40% of what physicians do is unnecessary, or doesn't work, or shouldn't be done. Lou Sullivan had that same number in 1989. We don't seem to be making much progress.

I see you've worked in utilization review as part of your background. Do you agree it's a problem, or are we on the way, or what should be done?

HOVEN: I think we as physicians are always conscious of cost, there's no question about it. But you must remember the environment in which we are practicing. We are still faced with the issues of medical liability, and I think until this country directs its attention in a meaningful way to medical liability reform doctors are going to "over practice," is what I like to call it.

LUNDBERG: That's called defensive medicine.

HOVEN: Right.

LUNDBERG: And there's still to be seen what medical liability reform would actually make that change, because defensive medicine becomes part of a culture of medicine.

HOVEN: Correct.

LUNDBERG: Young doctors learn to do this from the older doctors who are practicing defensively, so the young doctor may not even know she is practicing defensively.

HOVEN: And the other piece of this is what the patient wants or thinks they need, or their family wants or think they need. And we want to be as open and transparent with them about cost.

I think it's going to be very important as we move forward with comparative effectiveness data that we have, at the point of care in my exam room with the patient, I can show them relative value/risk benefits from therapies, or lack thereof, so that as a team -- the patient/the doctor, the family/the doctor -- we are making those decisions together in a way that is best for the patient and it will in the end improve the quality and the outcomes, and ultimately reduce the cost.

LUNDBERG: And that funds comparative effectiveness research as one of many things that it does in 2,700 pages. And is the AMA in support of PCORI [Patient-Centered Outcomes Research Institute] and PCORI's mission?

HOVEN: Very much so. That work, that engagement with patients and the patient-centered outcomes issues, are very important. And doctors want to be there in that space as well. We understand.

But it's going to be important for PCORI as they do their work to be sure physicians are involved, that physicians are at the table in the discussions with them, and that we are part of the dissemination of information to physicians and their patients.

LUNDBERG: And the AMA taking a lead in that, in terms of getting doctors deeply involved in PCORI work, I think will be very important.

HOVEN: Yes.

LUNDBERG: Thank you very much for being with us.

HOVEN: Thank you.

LUNDBERG: We've been talking with Dr. Ardis Hoven from Lexington, Ken., who is the incoming President-Elect of the American Medical Association.

And thank you for being with us as well. I'm Dr. George Lundberg, Editor-at-Large for MedPage Today, signing off.

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.